Page 1
• Hearing loss begins around the
third decade of life and its
incidence increases sharply with
age.
• Forty percent of those over age
sixty-five have measureable
hearing loss.
• Ninety percent of those ninety
years and older have hearing
loss.
HEARING & THE
EFFECTS OF AGING
Page 2
Hearing impairment in the elderly
has been associated with
psychological features such as:
• Depression
• Confusion
• Increased tension
• Negativism
• Inattentiveness
HEARING & THE
EFFECTS OF AGING
Page 3
Hearing impairment in the elderly
has also been associated with
functional problems such as:
• Poor general health
• Reduced mobility
• Reduced interpersonal
communications
HEARING & THE
EFFECTS OF AGING
Page 4
There are various forms of
Presbycusis (old-age hearing). We
need to keep in mind, that during
our lifetimes, we encounter a
variety of insults to our auditory
system such as: 1) noise exposure,
2) vascular disease, 3) concussive
damage, 4) pollutants, 5) ototoxic
drugs, 6) poor nutrition, 7) tobacco
HEARING & THE
EFFECTS OF AGING
Page 5
Aging effects of the outer and
middle ear structures occur.
However, studies do not support
significant conductive hearing loss
associated with these outer and
middle ear changes.
HEARING & THE
EFFECTS OF AGING
Page 6
Studies of the inner ear suggest
four specific types of presbycusis
may present. They are:
1. Sensory presbycusis
2. Neural presbycusis
3. Metabolic presbycusis
4. Mechanical or cochlear
conductive presbycusis
HEARING & THE
EFFECTS OF AGING
Page 7
Sensory Presbycusis
It is characterized by the
degeneration of hair cells and
supporting hair cells at the base of
the cochlea and subsequent
cochlear fiber degeneration.
HEARING & THE
EFFECTS OF AGING
Page 8
Neural Presbycusis
It is characterized by the loss of
cochlear neurons resulting in
problems with transmission of
information coding.
HEARING & THE
EFFECTS OF AGING
Page 9
Metabolic Presbycusis
Also known as strial presbycusis, it
is a result of the degeneration of
the Stria Vascularis which causes
disruptions in the nutrient supply
of the inner ear resulting in
modified cochlear electrical
potentials.
HEARING & THE
EFFECTS OF AGING
Page 10
Mechanical Presbycusis
It is characterized by alterations to
the cochlear mechanics produced
by mass/stiffness changes or spiral
ligament atrophy
HEARING & THE
EFFECTS OF AGING
Page 11
Audiograms may reflect a
summation of various
physiologic effects of aging of
the inner ear.
HEARING & THE
EFFECTS OF AGING
Page 12
Let’s review some signature
audiograms for the various
forms of presbycusis on page
#200 of Northern.
HEARING & THE
EFFECTS OF AGING
Page 13
Males and females over the age of
sixty exhibit hearing loss—
especially in the high frequency
regions.
HEARING & THE
EFFECTS OF AGING
Page 14
It has long been reported that
older persons experience greater
difficulty understanding
comfortably loud speech within the
presence of competing background
noise.
HEARING & THE
EFFECTS OF AGING
Page 15
Aging & Speech Recognition
When speech recognition scores
are assessed in quiet, there is little
performance difference between
young and elderly individuals.
HEARING & THE
EFFECTS OF AGING
Page 16
Various studies of the elderly and
speech recognition in noise
environments have concluded that
aging changes mechanisms within
the central auditory system.
HEARING & THE
EFFECTS OF AGING
Page 17
Dr. Jerger and colleagues
concluded that the understanding
problem of the elderly cannot be
totally explained by cognitive
decline or peripheral hearing loss.
Central deficits have to be a
contributing to the recognition
problem.
HEARING & THE
EFFECTS OF AGING
Page 18
Individuals with Central processing
disorders (CAPD), of any age, have
difficulty comprehending speech in
background noise.
HEARING & THE
EFFECTS OF AGING
Page 19
After reviewing the table on page
#204 of Northern, it is interesting
to see the nature of longstanding—
relatively mild hearing loss and its
effects upon the brain’s ability to
perform in background noise.
HEARING & THE
EFFECTS OF AGING
Page 20
Early intervention is
considered an important
rehabilitative strategy for
elderly individuals.
HEARING & THE
EFFECTS OF AGING
Page 21
Physicians help the elderly
maintain a quality of life. The vast
majority of elderly see physicians
for periodic health assessments.
However, physicians treat hearing
loss more as a benign condition
than truly posing a threat to the
more basic areas of human
performance.
HEARING & THE
EFFECTS OF AGING
Page 22
Let’s review the Sickness
Impact Profile (SIP) on page
#207 of Northern.
You can see that hearing loss
was strongly associated with
increased dysfunction in the
elderly.
HEARING & THE
EFFECTS OF AGING
Page 23
Efforts to improve the hearing
of elderly patients could result
in a significant and meaningful
improvement in the life quality
of older individuals.
HEARING & THE
EFFECTS OF AGING
Page 24
HEARING & THE
EFFECTS OF AGING
SYMPTOMATIC SIMILARITIES OF
ALZHEIMER’S DISEASE &
UNTREATED HEARING LOSS
Page 25
HEARING & THE
EFFECTS OF AGING
Alzheimer’s
Disease
• Depression,
Anxiety,
Disorientation
Untreated Hearing
Loss
• Depression,
Anxiety, Feelings
of Isolation
Page 26
HEARING & THE
EFFECTS OF AGING
Alzheimer’s
Disease
• Reduced
language
comprehension
Untreated Hearing
Loss
• Reduced
communication
ability
Page 27
HEARING & THE
EFFECTS OF AGING
Alzheimer’s
Disease
• Impaired
Memory (esp.
short term
memory loss)
Untreated Hearing
Loss
• Reduced
cognitive ability
Page 28
HEARING & THE
EFFECTS OF AGING
Alzheimer’s
Disease
• Inappropriate
psychosocial
responses
Untreated Hearing
Loss
• Inappropriate
psychosocial
responses
Page 29
HEARING & THE
EFFECTS OF AGING
Alzheimer’s
Disease
• Loss of ability
to recognize
(agnosia)
Untreated Hearing
Loss
• Reduced mental
scores
Page 30
HEARING & THE
EFFECTS OF AGING
Alzheimer’s
Disease
• Denial,
defensiveness,
negativity
Untreated Hearing
Loss
• Denial,
heightened
defensiveness,
negativity
Page 31
HEARING & THE
EFFECTS OF AGING
Alzheimer’s
Disease
• Distrust &
paranoia (e.g.
belief that
others may be
talking about
them)
Untreated Hearing
Loss
• Distrust &
suspicion
regarding
others’ motives
Page 32
Evidence of degeneration in
cortical areas and nuclei
associated with auditory function
in Alzheimer’s Disease is well
documented. Plaques within the
primary auditory area of the brain
have been revealed.
HEARING & THE
EFFECTS OF AGING
Page 33
In 1990, Mulrow and colleagues
reported that patients who
received amplification, exhibited
significant improvements in social
and emotional function, cognitive
function and reduced depression.
HEARING & THE
EFFECTS OF AGING
Page 34
Some reasons often cited as to
why the elderly do not access
hearing instruments are:
1. Insufficient knowledge about
hearing instruments
2. Unrealistic expectations of
hearing instruments
HEARING & THE
EFFECTS OF AGING
Page 35
Additional reasons for reduced
access may also include:
1. They have accepted the hearing
loss as a part of getting older.
2. Primary care physicians fail to
recognize and appreciate the
hearing impairment.
HEARING & THE
EFFECTS OF AGING
Page 36
Even if the patient complains
to the physician, more than
half of them will not be
referred for audiologic
evaluation.
HEARING & THE
EFFECTS OF AGING
Page 37
Unresolved widespread
acceptance of amplification by the
elderly has been the failure to
demonstrate that the use of a
hearing instrument (amplification)
will result in an improvement in
functional status and/or a quality
of life.
HEARING & THE
EFFECTS OF AGING